Transplant info Possible second opinion

Hi this is my first time posting on this site. My dad has cirrhosis of the liver. He hasn't ever been a heavy drinker or had hepatitis. The doctors best guess is that this was caused by fatty liver disease. His MELD score at the last dr visit was 15. We've been told previously that this is the level that would put him on the transplant list. But this time the doctor said that he isn't bad enough to be on the list yet. We've been pretty satisfied with his care so far, but not sure if another doctor might have a different opinion.

So I've been thinking about bringing my parents to Houston to get a second opinion if his MELD score is higher on the next visit and they still don't put him on the transplant list. Also, my husband is the same blood type as my dad and would consider donating part of his liver to my dad, but the doctor's at Tulane said that they don't do living donor transplants.

Any suggestions or ideas would be greatly appreciated. We've managed his condition for the last few years with diet and medicine, but his ammonia levels are starting to go up and I'm afraid that he is going to start getting worse a lot faster now.

Hi, Jules, and welcome to the forum! I'm sorry your dad is sick with liver disease. The main treatment for fatty liver is weight loss. It's unusual for a patient with fatty liver to need a transplant. Some hospitals will transplant around 17-20, but most are in their mid 20s to 40. It varies by center. What you must know is that a patient isn't just "put on the transplant list." He must go through a rigorous series of scans, tests, and consults. Based on the results of those, the transplant center where he is having this done will refer him to the transplant committee, which then decides whether or not to put him on the waiting list.

You may want to get a second opinion, but if his MELD remains at 15 then they may not consider him eligible for transplant just yet.

As for a living donor, only some transplant centers will do this. I know that Mayo doesn't do them.

What medications is he taking? Is he on Lactulose yet for elevated ammonia levels? Is he seeing a hepatologist?

Hugs,
Connie

Thank you for your information and kind words. We aren't sure what caused the cirrhosis. He has tested negative for all forms of hepatitis and as I said he has never been a heavy drinker. The occasional glass of wine or beer but certainly nothing to cause cirrhosis. Yes he is seeing a hepatologist at Tulane in New Orleans every 6 months and is followed more closely at home by his gastroenterologist. He had an episode last night where he tried to unlock his car with his cell phone. Up until this point we have let him drive and he has continued to work but now we won't allow him to drive. He had blood work done this morning and his ammonia level was 140. He has been on lactolose since the beginning but the doctor has increased his dosage until his ammonia level comes down. He has another doctor appointment in the morning.

I appreciate you telling me that most transplant centers don't transplant until the MELD is between 17-20. I guess we just have to be patient and hope that he continues to be stable.

If you want a second opinion Oschner in New Orleans and Willis Knighton in Shreveport have transplant centers.

If you can't get xifaxin, neomycin does a decent job with cleaning bacteria from the intestines. It's not as good as xifaxin, but is inexpensive. There is a drawback, in that it will add to your diarrhea production, along with lactulose. I used neomycin for about a year, before BC/BS decided to pay for it.